Yamana Tetsuo, Takahashi Tomoko, Iwadare Junichi
Department of Proctology, Social Health Insurance Hospital, 3-22-1 Hyakunincho Shinjuku-ku, Tokyo 169-0073, Japan.
Dis Colon Rectum. 2006 May;49(5):661-7. doi: 10.1007/s10350-006-0502-9.
This study was designed to evaluate the clinical and physiologic outcomes after transvaginal rectocele repair.
Between June 2000 and January 2003, 30 females (mean age, 62 (range, 45-78) years) with a symptomatic large rectocele (>3 cm) underwent transvaginal rectocele repair (anterior levatorplasty). Six months after surgery, a physiologic evaluation was performed by using defecography (depth of rectocele) and anorectal manometry (maximum resting pressure, maximum squeeze pressure, rectal threshold, and maximum tolerable volume). Using a questionnaire, a clinical evaluation was performed one year after surgery to analyze symptoms, including difficult evacuation, digital support, sexual discomfort, as well as patient satisfaction. Follow-up of all patients was conducted during a median duration of 38 (range, 23-54) months.
There were no operative complications, such as hematoma, wound infection, or rectovaginal fistula. Difficult evacuation improved in 27 of 30 patients (90 percent) and completely disappeared in 9 patients. Postoperatively, digital support was no longer necessary during evacuation in 15 of 21 patients (71 percent). Overall patient satisfaction reached 25 of 30 (83 percent). Although mild sexual discomfort was observed in nine patients, it disappeared gradually and only one patient complained of persistent symptoms. No patient reported symptomatic recurrences at the end of the follow-up. The radiologic mean depth of the rectocele was significantly reduced: preoperative, 3.9 cm; postoperative, 0.5 cm. None of the physiologic parameters significantly changed after surgery.
Transvaginal rectocele repair can provide excellent long-term symptomatic relief and a high rate of patient satisfaction without any alteration in anorectal physiologic function.
本研究旨在评估经阴道直肠膨出修补术后的临床和生理结果。
在2000年6月至2003年1月期间，30名有症状的巨大直肠膨出（>3 cm）女性（平均年龄62岁（范围45 - 78岁））接受了经阴道直肠膨出修补术（前盆底修复术）。术后6个月，通过排粪造影（直肠膨出深度）和肛肠测压法（最大静息压力、最大收缩压力、直肠阈值和最大耐受容量）进行生理评估。术后1年通过问卷调查进行临床评估，以分析包括排便困难、指压辅助、性交不适等症状以及患者满意度。对所有患者进行了中位时长38个月（范围23 - 54个月）的随访。
未出现诸如血肿、伤口感染或直肠阴道瘘等手术并发症。30例患者中有27例（90%）排便困难得到改善，9例完全消失。术后，21例患者中有15例（71%）在排便时不再需要指压辅助。患者总体满意度达到30例中的25例（83%）。尽管9例患者出现轻度性交不适，但逐渐消失，只有1例患者抱怨症状持续存在。随访结束时，无患者报告症状复发。直肠膨出的放射学平均深度显著降低：术前为3.9 cm；术后为0.5 cm。术后生理参数均无显著变化。
经阴道直肠膨出修补术可提供良好的长期症状缓解和较高的患者满意度，且不改变肛肠生理功能。
